LIA
1. The Evidence Bias
Evidence-Based-Medicine vs. Medicine-Based-Evidence
Dr. Victor Jean Ouellette, DC, MS
March 24, 2007
Evidence-Based-Medicine
Evidence-based-medicine is relatively new on the health care scene. For thousands of years health care was dispensed based on the concepts of medicine-based-evidence, trial and error so to speak. One practitioner’s error though, may be repeated by many other practitioners until standardization is hammered out by the practitioners themselves.
This new concept of evidence-based-medicine is the concept that a health care intervention should not be used unless there is scientific evidence that it will be of some value. This means that all worthwhile treatments and some offering cures, would be avoided until such a time as evidence was forthcoming.
This, of course, may take decades and represents a built in bias. Unrealistic it is, and so, a compromise is made. We, as a community, will encourage our health care providers to seek evidence for their treatment recommendations, while at the same time they will continuing to use professional-best-guess procedures. Thus, protocols are drafted and professionals are educated in those protocols. This is clearly an attempt at standardisation of health care interventions, and is considered as a good thing. We agree. When looked at closely the professional-best-guess concept is, in reality, the old style medicine-based-evidence at work.
Medicine-Based-Evidence
Medicine-based-evidence is a little different than the other way around. Lets transfer the words health care for the word medicine. We then have health-care-based-evidence as a more encompassing concept that would act as a guiding principle. This principle means that we look for pain reduction, increased function, and an improved general state of well being, as measures for the effectiveness of a treatment recommendation. These improvements can happen before the specific recommendation has been scientifically researched rigorously enough to make a conclusive statement about it. Much of the alternative medicine field falls into this category and as well, much of the traditional medical interventions also fall here. In fact, it can be argued that most of the medical interventions fall here.
The inter-professional arguments revolve around which professionals should use which treating principles, with which patients? Cold, low power, laser therapy for instance, incorporates the medicine-based-evidence into its intervention recommendations. If a patient’s pain gets better, the function improves, and the patient claims increased well being, then the laser treatment is considered a good treatment and is recommended to other patients. Acupuncture is another prime example and is soon to be regulated in Ontario. It is up to the scientists to look at the issues of efficacy and improvements in treatment efficiency. Until such a time as this further evidence is forth coming, the principle of health-care-based-evidence is used to justify the many treatments in all professions.
The community steps in
When large numbers of people become willing to pay for a treatment intervention, as the chiropractic patient base does, then those treatments become interwoven within health care delivery in the community. ‘Medicine-based-evidence’ delivery systems are a fact of life in our communities. They are notoriously difficult to do away with as the medical profession has found out over the last seventy five years or so. When people see less pain, improved function, and feelings of increased well being, they are willing to invest time and money to attain these worthy goals.
LIA
LIA stands for Lifestyle Instruction Aid. LIA involves optimal health secrets and pain relief self-help strategies. It is possible to measure each of the above parameters with a questionnaire. This opens the door for a service industry that focusses on the medicine-based-evidence approach using trained lay people instead of expensive professionals.
The LIA Project is taking the first steps to standardise optimal health secrets and pain relief self-help strategies in an attempt to improve the health of the community. The questions we should be asking are:
1. How do we lessen suffering in our population,
2. How do we save health care dollars,
3. How do we get the public to pay for this?
The LIA Project has the answers.
Optimal health secrets and pain relief self-help strategies,
doesn’t everybody want to know about that?
Don’t you want to know about that?
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